anxiety in some patients. For some surgical procedures, local anesthesia is impractical because of the number of injections and the amount of anesthetic medication that would be required (e.g., breast reconstruction) and might result in doses that would be toxic to the patient. The skin is prepared as for any surgical procedure, and a smallgauge needle is used to inject a modest amount of the anesthetic medication into the skin layers. This produces blanching or a wheal. Additional anesthetic medication is then injected into the skin until an area the length of the proposed incision is anesthetized. A larger, longer needle then is used to infiltrate deeper tissues with the anesthetic agent. The action of the agent is almost immediate, so surgery may begin shortly after the injection is complete. The anesthetic may be mixed with a fast-acting analgesic of short duration to circumvent the burning felt when the longeracting anesthetics are injected. Potential Intraoperative Complications The surgical patient is subject to several risks. Potential intraoperative complications include anesthesia awareness, nausea and vomiting, anaphylaxis, hypoxia, hypothermia, and malignant hyperthermia. The Surgical Care Improvement Project (SCIP) set a national goal to reduce surgical complications. Targeted areas include surgical site infections as well as cardiac, respiratory, and venous thromboembolic complications (Joint Commission, 2016).